Vanstone Meredith G, Krewulak Karla, Taneja Shipra, Swinton Marilyn, Fiest Kirsten, Burns Karen E A, Debigare Sylvie, Dionne Joanna C, Guyatt Gordon, Marshall John C, Muscedere John G, Deane Adam M, Finfer Simon, Myburgh John A, Gouskos Audrey, Rochwerg Bram, Ball Ian, Mele Tina, Niven Daniel J, English Shane W, Verhovsek Madeleine, Cook Deborah J
Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada.
J Crit Care. 2024 Jun;81:154761. doi: 10.1016/j.jcrc.2024.154761. Epub 2024 Mar 5.
The objective of this study was to create a definition of patient-important upper gastrointestinal bleeding during critical illness as an outcome for a randomized trial.
This was a sequential mixed-methods qualitative-dominant multi-center study with an instrument-building aim. In semi-structured individual interviews or focus groups we elicited views from survivors of critical illness and family members of patients in the intensive care unit (ICU) regarding which features indicate important gastrointestinal bleeding. Quantitative demographic characteristics were collected. We analyzed qualitative data using inductive content analysis to develop a definition for patient-important upper gastrointestinal bleeding.
Canada and the United States.
51 ICU survivors and family members of ICU patients.
Participants considered gastrointestinal bleeding to be important if it resulted in death, disability, or prolonged hospitalization. The following also signaled patient-important upper gastrointestinal bleeding: blood transfusion, vasopressors, endoscopy, CT-angiography, or surgery. Whether an intervention evinced concern depended on its effectiveness, side-effects, invasiveness and accessibility; contextual influences included participant familiarity and knowledge of interventions and trust in the clinical team.
Survivors of critical illness and family members described patient-important upper gastrointestinal bleeding differently than current definitions of clinically-important upper gastrointestinal bleeding.
本研究的目的是为一项随机试验创建一个关于危重症期间对患者重要的上消化道出血的定义作为一项结果指标。
这是一项以构建工具为目的的序贯混合方法主导的多中心研究。在半结构化的个人访谈或焦点小组中，我们收集了危重症幸存者和重症监护病房（ICU）患者家属对于哪些特征表明存在重要胃肠道出血的看法。收集了定量的人口统计学特征。我们使用归纳性内容分析法分析定性数据，以制定对患者重要的上消化道出血的定义。
加拿大和美国。
51名ICU幸存者及ICU患者的家属。
参与者认为，如果胃肠道出血导致死亡、残疾或住院时间延长，那么它就是重要的。以下情况也表明是对患者重要的上消化道出血：输血、使用血管升压药、进行内镜检查、CT血管造影或手术。一项干预措施是否引起关注取决于其有效性、副作用、侵入性和可及性；背景因素包括参与者对干预措施的熟悉程度和了解以及对临床团队的信任。
危重症幸存者和家属对患者重要的上消化道出血的描述与当前临床上重要的上消化道出血的定义不同。
